单侧面神经切除后面部运动特征定量分析  

Measurement of Facial Motion in Patients Undergone Facial Nerve Resection Using a Three-Dimensional Dynamic Quantitative Analysis System

作　　者：赵杨[1] 冯国栋 田旭[1] 奥登苏日塔 Gerd Fabian Volk Orlando Guntinas-Lichius 高志强[1] ZHAOYang;FENG Guodongv;TIAN Xu;Aodengsurita;Gerd Fabian Volk;Orlando Guntinas-Lichius;GAO Zhiqiang(Department of Otolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,China;ENT-Department and Facial Nerve Center Jena,Jena University Hospital,Jena,Germany)

机构地区：[1]中国医学科学院北京协和医院耳鼻喉科,北京100730 [2]ENT-Department and Facial Nerve Center Jena,Jena University Hospital,Jena,Germany

出　　处：《中华耳科学杂志》2019年第4期452-456,共5页Chinese Journal of Otology

基　　金：北京市自然科学基金面上项目(No.7182133)~~

摘　　要：目的应用面部三维动态定量分析系统(3-Dimensional Analysis System for Facial Motion,3D-ASFM)对面神经部分切除术后的患者进行测量,探讨修复与未修复患者面部静态和动态指标的变化。方法14例面神经部分切除患者,分为神经修复组(9例)和未修复组(5例)。对所有患者进行半年以上跟踪随访,中位随访期13个月。所有患者术前及术后均进行面部运动主观评估(House-Brackmann分级和Sunnybrook评分)和面部三维动态测量。比较三种评估结果相关性。比较修复组与未修复组患者术前、术后各评估结果,对修复组患者各面部区域进行分析。结果3D-ASFM分析结果分别与House-Brackmann分级(H-BGS)、Sunnybrook评分(SFGS)进行秩相关分析,相关系数分别为-0.707(P<0.05)和0.798(P<0.05)。面瘫越严重,3D-ASFM与主观评价系统的相关性越差。术后H-BGS、SFGS总分均存在统计学差异(P<0.05),修复组好于未修复组,3D-ASFM总分在两组间无统计学差异(P>0.05),但鼻旁运动好于未修复者。修复组患者术前、术后H-BGS、SFGS、3D-ASFM总分均无统计学差异(P>0.05)。所有患者健侧动态指标中,上面部运动较术前减小,下面部运动较术前增加。结论面部三维动态定量分析结果与传统主观评价系统有较好的相关性。神经修复对面中部运动影响最大。面神经切除手术不仅造成同侧面部运动改变,也会影响对侧面部运动。Objective To report long-term facial motion outcomes after facial nerve resection using a three-dimensional dynamic quantitative analysis system(3D-ASFM),including changes of static and dynamic facial parameters.Methods Fourteen patients who had undergone facial nerve resection were recruited,of whom 9 received facial nerve repair and 5 did not.All patients were followed up for more than half a year(median=13 months).All patients underwent subjective facial nerve evaluation by the House-Brackmann(H-BGS)and Sunnybrook facial grading system(SFGS),as well as examination using a 3D-ASFM before and after surgery.The correlation among the three evaluation systems was assessed and pre-and postoperative results were compared.Changes of different facial areas were analyzed.Results The results by the 3D-ASFM system correlated well with those by the H-BGS and SFGS scores(correlation coefficients=-0.707 and 0.798,respectively,P<0.05).The more severe the facial paralysis,the worse the correlation.Postoperative H-BGS and SFGS scores were better in patients with facial nerve repair than in those without(P<0.05),although there was no significant difference between the two groups by total 3D-ASFM score(P>0.05).Pre-and postoperative total H-BGS,SFGS and 3D-ASFM scores showed no significant difference among patients with facial nerve repair(P>0.05).Compared to preoperative results,motion parameters on the healthy side decreased in the upper face,but increased in the lower face.Conclusion The three-dimensional dynamic quantitative analysis system can provide facial motion information after nerve reconstruction in a more comprehensive and objective manner.Middle face is significantly affected by nerve reconstruction.Facial nerve resection causes changes not only on the diseased side,but also affects movements of contralateral side.

关 键 词：面部运动 面神经修复 三维动态 

分 类 号：R764[医药卫生—耳鼻咽喉科]